Addison’s disease is a common endocrinopathy often diagnosed in patients presenting with hyponatraemia. Cerebellar ataxia as a presentation of hyponatraemia is extremely rare. A 42-year-old man presented with vomiting, fever, ataxic gait and scanning type of dysarthria. Clinical examination revealed signs suggestive of isolated cerebellar involvement. Patient was found to have severe hyponatraemia and serum cortisol was found to be extremely low while MRI brain was found to be normal. Corticosteroid therapy was initiated and cerebellar ataxia was resolved following normalisation of sodium levels.

In decompensated cirrhosis, massive ascites and pleural effusion (hepatic hydrothorax) can be complicated by infection, which manifests either as spontaneous bacterial peritonitis (SBP) or spontaneous bacterial empyema (SBE). SBE is a distinct and often underdiagnosed complication having different pathogenesis and treatment strategy when compared with parapneumonic empyema. Hepatic hydrothorax in the absence of ascites is rare in patients with cirrhosis. The occurrence of SBE without SBP or ascites is even more of a rarity in cirrhosis and carries great morbidity and mortality. Here we report a case of an elderly female patient with cirrhosis (Child-Pugh Class B) who had unusual features of isolated right-sided hepatic hydrothorax without clinically evident ascites and was later diagnosed as having SBE based on imaging of the thorax, pleural fluid analysis, and cultures. The patient was initially treated conservatively with antibiotics, and diuretics, and later pigtail insertion and drainage was done.

Infective endocarditis is an infection commonly caused by bacterial pathogens and is known to affect intracardiac structures. We herein report a previously healthy man who presented with complications of infective endocarditis caused by Enterococcal faecalis and was further managed with appropriate antibiotics without the needed surgical interventions.

Background: Free thyroid hormone levels were analyzed in critically ill patients, admitted to the ICU who were more than 18 years of age without any underlying thyroid illness. APACHE 2, FT3, FT4, and TSH levels were analyzed and compared using ROC curves. Aim of the study: To assess whether free thyroid hormone levels were better predictors of outcomes compared to existing tools. Study design: This is a prospective observational study undertaken in the Department of General medicine at Sri Ramachandra institute of higher education and research, Chennai, Tamilnadu has done between 2019 to 2021 with the approval from the ethics committee. A total of 70 critically ill patients were admitted to the ICU, who were more than 18 years of age without any underlying thyroidal illness. Patients with known thyroid disease, pregnancy, and drugs causing alteration of thyroid hormone levels were excluded from the study. Blood samples were collected immediately after admission and APACHE 2 scores were calculated within 24 hours of admission. Parameters were analyzed using various statistical methods. Results: A total of 70 patients were included in the study, of which 63 were survivors and 7 patients expired. Most of the study population were males (45) and the mean age of the survivors 49.71 ± 10.72 was and for nonsurvivors was 54.29 ± 15.07. Using the Pearson correlation in APACHE 2 and FT3, APACHE 2 and FT4 showed a statistically signicant correlation in survivors (P 0.02; P 0.05), while in non-survivors only APACHE 2 and FT3 showed a signicant correlation ( P 0.008). Using ROC curves, APACHE 2 alone showed signicant predictive validity in predicting mortality in critically ill patients in our study ( AUC 0.985; P <0.001). Conclusion: In our study combined APACHE 2 and FT3 showed a signicant correlation in both survivors and non-survivors as well. APACHE 2 has better predictive value compared to other parameters and FT3 alone did not have predictive validity. So large sample is required to test the value of free thyroid hormones in predicting outcomes in critically ill patients.